I've heard that the sling procedure is especially helpful for pelvic prolapse. How do I know if I am a good candidate for it?
Dr. Wesley Hilger’s surgical practice goal is to improve a woman’s quality of life. After finishing a residency in Obstetrics and Gynecology he entered a three year fellowship program at the Mayo Clinic in Female Pelvic Medicine and Reconstructive Surgery. The program was unique in its emphasis on using minimally invasive techniques such as laparoscopy and the da Vinci Robotic System to address gynecologic issues such as urinary incontinence, vaginal relaxation or pelvic organ prolapse, endometriosis and uterine fibroids. Dr. Hilger utilizes the skills he gained in his fellowship training to help women get over often embarrassing and activity limiting problems and get on with the lives they want to live. His ability to use minimally invasive techniques means patients are out of the hospital in a day, have minimal pain and recover faster. Dr. Hilger strives to stay up to date with the latest technology by attending and teaching at national and international meetings.
Pelvic prolapse is a loss of support for the organs in the pelvis, including the bladder, uterus or rectum. When these organs shift out of position, they can cause symptoms that affect functioning, including urinary leakage, urinary frequency, or difficulty emptying the bladder or bowels. Other symptoms can include pelvic discomfort and even a bulge protruding from the vaginal opening that can be felt or seen.
The prolapse occurs because of a loss of the muscle and connective tissue support for the organs in the pelvis. Common causes are thought to include vaginal child birth, older age, chronic constipation, chronic cough, or chronic steroid use. The goal of treating pelvic prolapse is to alleviate symptoms and try to regain normal function of the affected organs. Treatment for pelvic prolapse can include non-surgical treatment - including a pessary - or different styles of surgical treatment.
Traditional repairs have involved the use of sutures and the patient’s own connective tissue. However, studies have indicated that some patients’ connective tissues may not be strong enough to give an adequate repair. In response to this, attempts have been made to develop materials to reinforce the weakened connective tissue. Most recently, synthetic materials have been utilized to create a netting or “sling” (other terms include mesh or graft). The netting is placed through the vagina to support the surrounding organs. The advantage of these materials is that they are much stronger then the surrounding connective tissue.
However, there is no perfect mesh netting. Early short term studies have shown that using a “mesh sling” may result in fewer re-occurrences of the prolapse as compared to traditional repair with sutures. However, there are no conclusive studies to show the superiority of these materials nor are there long term studies to show how repair holds up over time.
Also, complications with the materials can occur including infection, pain, or erosion of the mesh into the surrounding organs, requiring additional surgery to remove the sling. These revision surgeries are more challenging than the initial procedure of placing the netting. In fact, concern regarding the complications that can occur with the materials caused the FDA put out a warning regarding their use (http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm#popsui).
I believe that these materials can play a helpful role in pelvic prolapse repair in a select population of patients. However, the patient must be carefully counseled on the risks, benefits and alternatives. In addition, the patient should make sure the surgeon has experience with the sling procedure and knows how to deal with potential complications.